Sample Confidentiality Contract for Clinical Staff,Trainees, & Employees With Access to Patient Information in Mental Health Settings

(Including Students, Supervisees, & Volunteers in your “Workforce”)

LETTERHEAD

CONFIDENTIALITY STANDARDS:
All patient information is to be treated as confidential, including the fact that the patient receives (or previously received) services through this office. The privacy and confidentiality of our patients are protected under the Ethics Codes of the mental health professions, state laws and regulations, and federal HIPAA Regulations. No patient information may be disclosed without the explicit informed consent of the patient and authorization by his/her clinician.

The following would be inappropriate, unethical, and/or illegal:

== Discussing/revealing patient information to anyone outside this office (e.g., friends, family, fellow students or supervisees, etc.).
== Removing any patient information from this office for any purpose (including working from home) without explicit authorization from the patient’s clinician in each case.
== Discussing/revealing patient information to another employee who has no legitimate need to know.
== Obtaining access to patient information not directly necessary for performing your job duties.
== Copying patient files or other patient information onto your own computer
==Sending any patient information via e-mail or FAX without explicit authorization from the clinician.
== Copying patient files or other patient information onto CD, floppy disk, or other electronic medium, without explicit authorization from the patient’s clinician for a specific purpose, except when conducting authorized computer backup on a scheduled basis.
== Placing patient information on the internet or into any other publicly-available forum without consent.

EMPLOYEE CONFIDENTIALITY AGREEMENT
I hereby acknowledge, by my signature below, that I understand that any patient information to which I have access is considered confidential, including clinical records, financial records, or any other identifiable information about